Dr Andrew Pumerantz Reflects on the Role of Primary Care in Diabetes

Although primary care is important, it may not be the center of the care model for patients with chronic diseases, like type 2 diabetes, and these providers are usually just a part of a larger ecosystem of providers, said Andrew Pumerantz, DO, FACP, executive director of the Western Diabetes Institute and associate professor of Internal Medicine at Western University of Health Sciences.

Transcript (modified slightly for readability)

The majority of patients with type 2 diabetes are treated by primary care physicians. What mistakes might these providers make when trying to motivate patients with diabetes to diet or start exercising?

I hate to cast aspersions or be judgmental of providers because I think everybody is trying to do the right thing and everyone’s intentions are in the right place. I think that somehow the unintended consequences of the way healthcare providers recommend advice and treatments for people may come across as very paternalistic.

Many of us don’t look or reflect the community and our patients look like. We may have grown up in a different place and we may have educational opportunities they didn’t have. So there is a difference between a lot of the people we care for and who we are as providers. We have to recognize there may be potential barriers there that may not be that obvious.

I think, historically, the model of “Let me give you some advice or let me give you this piece of paper” is correction information, but it’s not necessarily being delivered or internalized.

The whole understanding with regards to primary care physicians is realize that their job is almost like “mission impossible.” They’ve got to do a whole bunch of different stuff for different people. They’ve got to provide acute care, diagnosis, and management for acute illnesses—maybe self limiting or maybe not. They also are faced with a whole population of people who have chronic complex conditions and those individuals may also have 11 other providers across their ecosystem. So they may have an eye doctor and a foot doctor and a dentist, etc.

The primary care provider is one piece of that entire ecosystem and so if they understand that although primary care serves a role, it is not by itself in the center of the care model for these patients.